Ultrasonic Bone Curette‐Assisted Unilateral approach for bilateral decompression with MISTLIF for Severe lumbar spinal stenosis

Abstract Purpose We aim to evaluate the clinical efficacy of bilateral decompression with minimally invasive transforaminal lumbar interbody fusion (MISTLIF) assisted by ultrasonic bone Curette (UBC) in treating severe degenerative lumbar spinal stenosis (DLSS) and traditional tool laminectomy decompression MISTLIF in treating severe DLSS. Methods The clinical data of 128 patients with single-segment severe DLSS admitted between January 2017 and December 2021 were retrospectively analyzed. Among them, 67 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using ultrasonic bone Curette (UBC group), whereas 61 patients were treated with unilateral fenestration and bilateral decompression MIS-TLIF using traditional tools (traditional group, control). A visual analog scale (VAS) was used to evaluate the low back pain before the operation, one week, and 1, 3, 6, 12, and 24 months after the operation. Oswestry disability index (ODI) and Zurich claudication score (ZCQ) were used to evaluate the improvement of low back function. At the last follow-up, the Bridwell bone graft fusion standard was used to evaluate the bone graft fusion. Results The decompression time of laminectomy was significantly shorter in the UBC group than in the traditional group (control group), and the intraoperative blood loss and postoperative drainage volume were significantly less than those in the control group (P < 0.05). The VAS, ODI, and ZCQ scores of the two groups after the operation were significantly improved compared to those before the operation (P < 0.05). The UBC group had better VAS and ODI scores than the control group one week after operation (P < 0.05). The incidence of perioperative complications, hospitalization time, dural sac cross-sectional area (CSA), and dural sac CSA improvement rate did not differ significantly between the two groups (P > 0.05). VAS and ODI scores did not differ significantly between the two groups before, six months, one year, and two years after operation (P > 0.05). ZCQ score did not differ significantly between the two groups before the operation, one week, six months, one year, and two years after the operation (P > 0.05). According to the Bridwell bone graft fusion standard, bone graft fusion did not occur significantly between the two groups (P > 0.05) at the last follow-up. Conclusions UBC unilateral fenestration bilateral decompression MIS-TLIF in treating severe DLSS can obtain similar clinical efficacy as traditional tools unilateral fenestration bilateral decompression MIS-TLIF and can reduce intraoperative blood loss and postoperative drainage. It can also shorten the operation time, effectively reduce the work intensity of the operator, and reduce the degree of low back pain during short-term follow-up. It is a safe and effective surgical method.